Healthcare Provider Details

I. General information

NPI: 1386931780
Provider Name (Legal Business Name): MOUNTAIN TOP TRANSPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 PENROD LN
OVERGAARD AZ
85933-1118
US

IV. Provider business mailing address

P.O. BOX 1118
OVERGAARD AZ
85933-1118
US

V. Phone/Fax

Practice location:
  • Phone: 855-686-7433
  • Fax: 928-535-3264
Mailing address:
  • Phone: 855-686-7433
  • Fax: 928-535-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License NumberL16778337
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberL16778337
License Number StateAZ

VIII. Authorized Official

Name: MS. DORRI ANNE THYDEN
Title or Position: CEO
Credential:
Phone: 202-271-1434